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Monday, July 28, 2014

Does hospital reimbursement laws impact disease trends?

Your question:  My friends were arguing about government involvement in medicine.  One said it's good, but the other said government involvement make it difficult, if not impossible, to track trends in various diseases.  What do you think of this? Do you think it's true? Why?

My answer:  Without delving too deep into politics, I'll try to explain what your friend was probably trying to say.  Asthma rates have skyrocketed since 1980.  So does that mean more people are getting asthma?  Maybe.  But it was just prior to 1980 that DRGs were created, and this made it so physicians and hospitals were reimbursed based on diagnosis rather than procedure.  For instance, insurance companies only pay for pulmonary function testing if there is a diagnosis of asthma.  So, some speculate this has caused many physicians to write "asthma" on the diagnosis line even when there is not asthma. So are there actually more asthmatics today than in 1980? Some say it's hard to know because of government intervention.

Similarly, pneumonia and COPD are highly reimbursable.  However recent laws have made it so CMS will not reimburse the hospital when pneumonia and COPD patients are readmitted within so many days.  Now, since patients with COPD have nearly a 50-50 chance of getting readmitted, physicians, you might expect, might be less likely to write "COPD" on the diagnosis line.  However, since pneumonia patients are less likely to be readmitted, that will likely be the diagnosis.  Thirty years down the line it might look like there are fewer COPD patients and more pneumonia patients.  Experts will be looking at these diseases like we look at asthma today: are these trends accurate?

The bottom line is money.  While CMS will say they are doing this to help patients and improve patient care, the true reason is to save money. The result is that it has become difficult, if not impossible, for experts to know the true cause of whether disease rates are rising and falling.   In my opinion, it would be best to allow doctors to treat and diagnose as they feel is appropriate, and not on whether they will be reimbursed.

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